Department of Surgery, University Hospital Fundación Jiménez Díaz, Madrid, Spain.
Department of Surgery, University Hospital Ramón y Cajal, Madrid, Spain.
Surgery. 2022 Apr;171(4):932-939. doi: 10.1016/j.surg.2021.08.047. Epub 2021 Nov 1.
Bone disease in primary hyperparathyroidism is a clear indication for surgical treatment. However, it is not known whether surgery benefits hypercalcemic primary hyperparathyroidism and normocalcemic primary hyperparathyroidism equally. The aim of our study was to evaluate the bone changes in patients undergoing parathyroidectomy based on the biochemical profile 1 and 2 years after surgery.
This prospective study included 87 consecutive patients diagnosed with primary hyperparathyroidism who underwent surgery between 2016 and 2018. Bone densitometry (1/3 distal radius, lumbar, and femur) and bone remodeling markers (osteocalcin, type 1 procollagen [P1NP], β-cross-linked telopeptide of type I collagen [BCTX]) were performed preoperatively and postoperatively. Postoperative changes in bone mineral density and bone markers were compared and evaluated according to the clinical characteristics and the individual biochemical profile.
One year after surgery, all patients showed an increase in bone mineral density at the lumbar site (mean, 0.029 g/cm; range, 0.017-0.04; P < .001) and femur neck (mean, 0.025 g/cm; range, 0.002-0.05; P < .001); however, there were no changes in the distal third of the radius (mean, -0.003 g/cm; range, -0.008 to 0.002; P = NS). There were no significant differences when comparing normocalcemic primary hyperparathyroidism and hypercalcemic primary hyperparathyroidism. Serum osteocalcin (37 ± 17.41), P1NP (67.53 ± 31.81) and BCTX (0.64 ± 0.37) levels were elevated before surgery. One year after the surgery, we observed a significant decrease in P1NP (33.05 ± 13.16, P = .001), osteocalcin (15.80 ± 6.19, P = .001), and BCTX (0.26 ± 0.32, P < .001) levels.
Our findings indicate that parathyroidectomy has similar benefits for normocalcemic primary hyperparathyroidism and hypercalcemic primary hyperparathyroidism in terms of bone improvement. Although the most substantial improvement occurred during the first postoperative year in both groups, we consider that studies with longer follow-up are warranted.
原发性甲状旁腺功能亢进症的骨病是手术治疗的明确指征。然而，目前尚不清楚手术是否对高钙血症原发性甲状旁腺功能亢进症和正常钙血症原发性甲状旁腺功能亢进症同样有益。我们的研究目的是评估手术后 1 年和 2 年患者甲状旁腺切除术的骨变化，基于生化特征。
这项前瞻性研究包括 87 例在 2016 年至 2018 年间接受手术的原发性甲状旁腺功能亢进症患者。在术前和术后进行骨密度（1/3 远端桡骨、腰椎和股骨）和骨重塑标志物（骨钙素、I 型前胶原 [P1NP]、I 型胶原β交联端肽 [BCTX]）检查。根据临床特征和个体生化特征比较和评估术后骨矿物质密度和骨标志物的变化。
术后 1 年，所有患者的腰椎（平均增加 0.029 g/cm；范围 0.017-0.04；P <.001）和股骨颈（平均增加 0.025 g/cm；范围 0.002-0.05；P <.001）的骨矿物质密度增加；然而，桡骨远 1/3 处没有变化（平均减少 0.003 g/cm；范围 0.008-0.002；P = NS）。正常钙血症原发性甲状旁腺功能亢进症和高钙血症原发性甲状旁腺功能亢进症之间没有显著差异。血清骨钙素（37 ± 17.41）、P1NP（67.53 ± 31.81）和 BCTX（0.64 ± 0.37）水平在术前升高。手术后 1 年，我们观察到 P1NP（33.05 ± 13.16，P =.001）、骨钙素（15.80 ± 6.19，P =.001）和 BCTX（0.26 ± 0.32，P <.001）水平显著降低。
我们的发现表明甲状旁腺切除术对正常钙血症原发性甲状旁腺功能亢进症和高钙血症原发性甲状旁腺功能亢进症在改善骨方面具有相似的益处。尽管两组患者在术后第 1 年的改善最为显著，但我们认为需要进行更长时间的随访研究。
